Chapter Thirteen Eye and Adnexa

Chapter Thirteen Eye and Adnexa
There are five senses; however, taste, touch, and smell are discussed in other chapters. Mastering Healthcare Terminology/Chapter 14

The Eye and the Adnexa Functions Anatomy and physiology
Vision (ocul/o, ophthalm/o) Capture and focus versus interpretation of images Anatomy and physiology Eye Oculus sinistra Oculus dextra Oculus uterque Ocular adnexa The eye and adnexa are responsible for an individual’s sense of vision by capturing and focusing light rays on the retina. The interpretation of those images is handled by the nervous system. The eye (eyeball) is a bilateral structure. The left eye is referred to as oculus sinistra, while the right is termed oculus dextra. If medication is required in both (each) eyes, the notation is oculus uterque. Note that the Institute for Safe Medical Practice has designated the abbreviations OD (right eye), OS (left eye), and OU (each eye) as dangerous abbreviations. The recommendation is to write out the full terms. The ocular accessory structures are the structures outside of the globe of the eyeball that aid in the acquisition of vision. Mastering Healthcare Terminology/Chapter 14

Ocular adnexa Orbit Word Parts Eyebrows Canthi Eyelids Conjunctivae
Palpebral fissure Palpebration Conjunctivae Word Parts ophthalm/o, ocul/o = eye orbit/o = orbit/o blephar/o, palpebr/o = eyelid canth/o = canthus conjunctiv/o = conjunctiva Vision is accomplished through the eyeball and its adnexa. Use the diagram to explain the names for the parts listed. The protective, bony socket that holds the eye is called the orbit. The eyebrows mark the area above the orbit (supraorbital) and help keep the sun and perspiration from getting in one’s eyes. The corners of the eyes are called the canthi (s. canthus). The lateral canthus is the outer corner and the medial canthus is the corner that is closer to the nose. The area in which the upper and lower eyelids close is called the palpebral fissure. Palpebr/o and blephar/o are combining forms for the eyelids. The term “fissure” is used throughout medical terminology to mean a deep slit, whether it is between the eyelids, in the skin, or on a bone. The act of blinking is called palpebration, obviously derived from one of the combining forms. Be careful not to confuse palpebrate with palpate or palpitate. The thin protective mucous membrane that spreads to coat the anterior surface of the eyeball and the eyelids is called the conjunctiva (conjunctivae). Ocular adnexa Mastering Healthcare Terminology/Chapter 14

CM Guideline Alert B13. Laterality
For bilateral sites, the final character of the codes in the ICD-10-CM indicates laterality. An unspecified side code is also provided should the side not be identified in the medical record. If no bilateral code is provided and the condition is bilateral, assign separate codes for both the left and right side. Ask the students if the idea of being mindful about bilateral sites is beginning to sink in. Mastering Healthcare Terminology/Chapter 14

Be Careful! Tars/o can refer to a flat structure that gives shape to the eyelid (the tarsal plate) or to bones in the ankle. From the Greek word tarsus meaning of a flat surface, it refers to the horizontal level appearance of each eyelid and also the bones that make up the instep of the foot. The term palpebrate means to blink or wink. Do not confuse this with the term palpate (meaning to touch) or palpitate (meaning to throb). When the material is new, and students are trying to learn this new language, it is a good idea to point out potential terms of confusion. Mastering Healthcare Terminology/Chapter 14

Glands Meibomian Word Parts Lacrimal Lacrimation Lacrimal glands
Lacrimal sacs Nasolacrimal ducts Word Parts dacryoaden/o = lacrimal (tear glands) dacryocyst/o = lacrimal (tear) sac lacrim/o, dacry/o = tears nas/o = nose There are two types of glands that serve the eyes. The meibomian glands are sebaceous glands that secrete oil to lubricate the eyelashes, whereas the lacrimal glands, located above the eyeballs, produce tears. The tears have a cleansing as well as a lubricating function. The process of producing tears is termed lacrimation. As tears are produced form the upper outer corners of the orbit, blinking spreads the tears across the surface of the eye. The tears then drain into two small holes (the lacrimal puncta) in the medial canthi, into the lacrimal sacs, and then into the nasolacrimal ducts, which carry the tears to the nasal cavity. The extraocular muscles attach the eyeball to the orbit and on impulse from the cranial nerves move the eyes. These six voluntary (skeletal) muscles are made up of four rectus (straight) and two oblique (diagonal) muscles. Explain how the nasolacrimal ducts are part of the reason you need to blow your nose when you cry. Mastering Healthcare Terminology/Chapter 14

Extraocular muscles Rectus Word Parts Oblique Annulus of Zinn
Don’t confuse with the zonules of Zinn Levator palpebrae Orbicularis oculi Word Parts extra- = outside ocul/o = eye -ar = pertaining to rect/o = straight annul/o = annulus, ring palpebr/o = eyelid The extraocular muscles attach the eyeball to the orbit and provide a means of movement for the eyes. There are six voluntary muscles, four rectus (straight) and two oblique. Five of the six muscles originate in a ringlike structure behind the eyeball termed the annulus of Zinn (note the synonym, annular tendon). The zonules of Zinn are a structure in the lens, not the extraocular muscles. The muscles that raise the eyelids are the levator palpebrae superior, while the orbicularis oculi are the sphincter muscles that close the eye. Mastering Healthcare Terminology/Chapter 14

The Eyeball Eyeball viewed from above Anterior view of the eyeball
Mastering Healthcare Terminology/Chapter 14

Eyeball Outer layer/fibrous tunic Word Parts Sclera Episcleral layer
Schlemm’s canal Scleral venous sinus Trabecular network Cornea Limbus Word Parts scler/o = sclera epi- = above, upon kerat/o, corne/o = cornea limb/o = limbus Eyeball The eyeball is arranged in three layers/tunics. The outer layer/fibrous tunic is composed of the sclera and cornea. The sclera is the outermost lateral and posterior portion of the eye, referred to generally as the white of the eye. The three layers of the sclera are the episcleral layer, Schlemm’s canal (aka the scleral venous sinus), and the deepest layer, the trabecular network. While the episcleral layer is protective, Schlemm’s canal is a ringlike tube that returns fluid to the bloodstream. The trabecular network serves to drain fluid from the eye to maintain a healthy intraocular pressure. The portion of the sclera that covers the anterior section of the eye that is transparent is called the cornea. The border between the two is called the limbus. Use the diagrams to explain the parts of the layers and the combining forms. Note the use of kerat/o and scler/o in other chapters with different meanings. Kerat/o means “hard, horny” in the skin chapter and scler/o also means “hard” in sclerotherapy in the skin chapter. Be careful not to confuse core/o and corne/o. Mastering Healthcare Terminology/Chapter 14

Be Careful! The combining form kerat/o refers to the structure of the cornea, but also to the condition of a body part having a “hard or horny” appearance, such as a seborrheic keratosis. More combining forms cross over body systems. What is the reason? Mastering Healthcare Terminology/Chapter 14

Middle layer/vascular tunic
Uvea (choroid, ciliary body, iris) Iris Pupil Ciliary body Pars plana Zonule of Zinn Crystalline lens Aqueous and vitreous humors Word Parts uve/o = uvea choroid/o = choroid cycl/o = ciliary body ir/o, irid/o = iris pupill/o, core/o, cor/o = pupil phak/o, phac/o = lens vitre/o = vitreous humor The middle layer/vascular tunic is composed of the uvea, which is made up of the choroid, ciliary body, and iris. The choroid is the vascular supply (blood). The ciliary body consists of the strands of muscle tissue that hold the lens in place and secrete fluid that forms the aqueous humor. The pars plana is the flat part of the ciliary body. The zonules of Zinn are the tiny extensions from the processes that attach to the lens. The iris (pl. irides) is a smooth muscle that contracts and relaxes to moderate the amount of light that enters the eye. Most individuals have a pigmented iris (brown, gray, hazel, blue), but because some individuals lack the pigment (albinism) their irides are reddish-pink because of the blood traveling through the vessels that supply each iris. The pupil is the dark area in the center of the iris in which the light continues its progress through to the lens. The lens is an avascular (a- without + vascul/o = vessel + -ar = pertaining to) structure that is made up of protein and is covered by an elastic capsule. It is held in place by thin strands of muscle that make up the ciliary body. The fluid produced by the capillaries of the ciliary body is called the aqueous humor. It nourishes the cornea, gives shape to the anterior eye, and maintains an optimum intraocular pressure. It normally drains through tiny veins called the canals of Schlemm. The vitreous humor is a jellylike substance that holds the choroid membrane against the retina to ensure an adequate blood supply. Mastering Healthcare Terminology/Chapter 14

Be Careful! Core/o and cor/o are combining forms for the pupil of the eye and corne/o is a combining form for the cornea. Again, attention to detail is important in the medical field, and that attention to detail needs to extend to its language, medical terminology. These are good examples. Mastering Healthcare Terminology/Chapter 14

PCS Guideline Alert B2.1 Body systems contain body part values that include contiguous body parts. These general body part values are used: a. when a procedure is performed on the general body part as a whole b. when the specific body part cannot be determined c. in the root operations change, removal and revision, when the specific body part value is not in the table. Does everyone know that contiguous means touching? Detailed knowledge of anatomy is important to be able to determine these structures. Mastering Healthcare Terminology/Chapter 14

Inner layer/nervous tunic
Retina Rods Cones L, M, S Macula lutea Fovea centralis Optic disk Optic papilla Ora serrata Word Parts retin/o = retina papill/o = optic disk macul/o = macula lutea The inner layer of the eye, called the retina, contains the sensory receptors for the images carried by the light rays. These sensory receptors are either rods, which appear throughout the retina and are responsible for vision in dim light, or cones, which are concentrated in the central area of the retina and are responsible for color vision. (It’s easy to remember that the cones are responsible for color vision, because cones and color both start with “c.”) There are three types of cones, named L, M, and S for the wave lengths of light that they react to (long, medium, short). Difficulties with color vision refer to these specific cones. During daylight, the area of the retina on which the light rays focus is called the macula lutea. Macul/o is a combining form meaning “spot” and is seen in the skin (macules) and also in the utricle and saccule of the labyrinth of the ear. The fovea centralis is an area within the macula that contains only cones and provides the sharpest image. (The term fovea literally means a small pit, something that is also seen in naming bone structures.) The area that allows a natural blind spot in our vision is the optic disk (also called the optic papilla), where the optic nerve leaves the retina to travel to the brain. There are no light receptors there. Finally the ora serrata (or is the plural of os, meaning “an opening”, and serrata means “notched”) is the jagged edge between the retina and the ciliary body of the choroid. Mastering Healthcare Terminology/Chapter 14

Vision Refraction Accommodation Errors of refraction
When the ocular adnexa eyeballs work together, the transmission of light rays provide a sense of vision. The light rays are bent as they pass through the cornea (refraction) to be projected onto the retina. The muscles in the ciliary body adjust the shape of the lens to see items either close or far (accommodation). Errors of refraction are the most common visual disorders. Nearsightedness (myopia) and farsightedness (hypermetropia) are two that students may recognize. Mastering Healthcare Terminology/Chapter 14

Clicker Question A combining form for the lens is: A. palpebr/o
B. phak/o C. cor/o D. cycl/o B. phak/o Mastering Healthcare Terminology/Chapter 14

Disorders of the Eyelid, Lacrimal System, and Orbit (H00-H05)
Blepharitis Blepharochalasis Blepharoptosis Word Parts blephar/o = eyelid -itis = inflammation -chalasis = relaxation -ptosis = drooping, sagging, prolapse Blepharitis is an inflammation of the eyelid, while blepharochalasis is a relaxation or slackening of the eyelid as a result of hypertrophy. Blepharoptosis is a drooping of the upper eyelid. Mastering Healthcare Terminology/Chapter 14

Review Question What is the term for a drooping of the upper eyelid?
A. blepharitis B. blepharochalasis C. blepharoptosis D. entropion C. blepharoptosis -ptosis = drooping Mastering Healthcare Terminology/Chapter 14

Dacryoadenitis Dacryocystitis Lacrimal canaliculitis Epiphora Word Parts dacryoaden/o = lacrimal gland -itis = inflammation dacryocyst/o = lacrimal sac lacrim/o = tear canalicul/o = little canal Dacryoadenitis is an inflammation of a lacrimal gland, while dacryocystitis is inflammation of the lacrimal sac. Lacrimal canaliculitis is an inflammation of the tear ducts, especially the lacrimal canaliculi. Epiphora is an overflow of tears = excessive lacrimation. Mastering Healthcare Terminology/Chapter 14

Chalazion Hordeolum Exophthalmos Word Parts ex- = out ophthalm/o = eye -os = condition Chalazion Chalazion is a hardened swelling of a meibomian gland resulting from a blockage. Also called a meibomian cyst. A hordeolum is an infection of one of the sebaceous glands of an eyelash. It is commonly called a stye. Exophthalmos is a protrusion of the eyeball from its orbit; may be congenital or the result of an endocrine disorder. Exophthalmos Hordeolum Mastering Healthcare Terminology/Chapter 14

Ectropion Entropion Word Parts ec- = out trop/o = turning -ion = process of en- = in Ectropion is an outward (eversion) turning of the eyelid, exposing the conjunctiva. Entropion is an inward turning of the eyelid toward the eyeball. Ectropion Entropion Mastering Healthcare Terminology/Chapter 14

Conjunctiva Disorders (H10-H11) Conjunctivitis Pinguecula Pterygium
Pingueculitis Pterygium Word Parts conjunctiv/o = conjunctiva -itis = inflammation pteryg/o = wing -ium = structure Conjunctivitis is an inflammation of the conjunctiva and is commonly termed “pinkeye.” It is a highly contagious disorder. Pinguecula is a yellowish noncancerous growth on the conjunctiva covering the eyeball in the area of the palpebral fissure. If irritated, it is termed pingueculitis. Pterygium is a winglike growth of the conjunctiva at the medial canthus of the eye. It is usually as a result of excessive exposure to the wind and/or the weather. Conjunctivitis Mastering Healthcare Terminology/Chapter 14

Disorders of Sclera, Cornea, Iris, and Ciliary Body (H15-H22)
Hyphema Iridocyclitis Keratitis Keratomalacia Scleritis Synechia Uveitis Word Parts hypo- = under hem/o = blood -a = noun ending irid/o = iris cycl/o = ciliary body -itis = inflammation kerat/o = cornea -malacia = softening scler/o = sclera uve/o = uvea Hyphema is a condition of blood in the anterior chamber of the eye as a result of hemorrhage due to trauma. Iridocyclitis is an inflammation of the anterior uvea, specifically the iris and ciliary body. The symptoms of iridocyclitis include photophobia (sensitivity to light) and miosis (constriction of the pupil) and synechia (adhesion of the cornea to the lens). Keratitis is an inflammation of the cornea, while keratomalacia is a softening of the cornea. Keratomalacia is the result of a vitamin A deficiency and malnutrition. It often leads to xerophthalmia (dry eye) and nyctalopia (night blindness). Scleritis is an inflammation of the sclera and is usually associated with autoimmune disorders. Uveitis is an inflammation of the uvea (the iris, ciliary body, and choroid). Mastering Healthcare Terminology/Chapter 14

Disorders of the Lens (H25-H28) Aphakia Cataract
Word Parts a- = no, not, without phak/o = lens -ia = condition Aphakia is a condition of no lens, either congenital or acquired. A cataract is a progressive loss of transparency of the lens of the eye. Age-related (senile) cataracts can be classified as opacities of the lens in the center (nuclear) or on the periphery (cortical). Cataract Mastering Healthcare Terminology/Chapter 14

Disorders of Choroid and Retina (H30-H36)
Age-related macular degeneration (ARMD or AMD) Posterior cyclitis Retinal ischemia Retinal tear, retinal detachment Retinitis pigmentosa Word Parts cycl/o = ciliary body -itis = inflammation retin/o = retina -al = pertaining to isch/o = hold back, suppress -emia = blood condition ARMD is a progressive destruction of the macula, resulting in a loss of central vision. This is the most common type of loss of vision over the age of 75. It appears as wet (exudative) or dry (nonexudative) forms depending on whether or not there is bleeding and leaking under the macula. Posterior cyclitis is an inflammation of the ciliary body. It is also referred to as pars planitis because the pars plan is a structure within the ciliary body. Retinal ischemia is a lack of blood flow to the retina. Why is this a problem? A retinal tear or retinal detachment is a separation of the retina from the choroid layer. It may be due to trauma, inflammation of the interior of the eye, or aging. The resulting hole in the retina allows fluid from the vitreous humor to leak between the two layers. Retinitis pigmentosa is a hereditary, degenerative disease marked by nyctalopia and a progressive loss of the visual field. ARMD Mastering Healthcare Terminology/Chapter 14

Glaucoma (H40-H42) Glaucoma Open-angle glaucoma Word Parts
Chronic/primary angle glaucoma Angle-closure/narrow-angle glaucoma Word Parts glauc/o = gray, bluish green -oma = mass, tumor Glaucoma acquires its name from its appearance as a gray, bluish-green mass in the eye. While not a tumor, glaucoma is a group of disorders that are characterized by abnormal intraocular pressure due to obstruction of an outflow of the aqueous humor. Chronic or primary open-angle glaucoma is characterized by an open anterior chamber angle. Angle-closure or narrow-angle glaucoma is characterized by an abnormally narrowed anterior chamber angle. Open-angle glaucoma Mastering Healthcare Terminology/Chapter 14

Disorders of Vitreous Body and Globe (H43-H44) Panophthalmitis
Purulent endophthalmitis Word Parts pan- = all ophthalm/o = eye -itis = inflammation endo- = within These two terms are easily decoded. Panophthalmitis is an inflammation of the entire (all) eye. Purulent endophthalmitis is an infection within the eyeball usually caused by a bacterial infection. Remember that the term purulent means pertaining to pus. Mastering Healthcare Terminology/Chapter 14

Disorders of Optic Nerve and Visual Pathways (H46-H47) Optic neuritis
Optic papillitis Papilledema Retrobulbar neuritis Word Parts opt/o = vision -ic = pertaining to neur/o = nerve -itis = inflammation papill/o = optic disk -edema = swelling retro- = behind bulb/o = globe -ar = pertaining to Optic neuritis is an inflammation of the optic nerve. This disorder is often mentioned as a disease that many patients with multiple sclerosis have experienced. Optic papillitis is an inflammation of the optic disk, usually accompanied by varying degrees of visual deficiencies. Papilledema is a swelling of the optic disk, usually secondary to intracranial pressure. Retrobulbar neuritis is an inflammation of the optic nerve behind the eyeball. This is a type of optic neuritis. Mastering Healthcare Terminology/Chapter 14

Astigmatism (astig. As, Ast) Esotropia Exotropia
Disorders of Ocular Muscles, Binocular Movement, Accommodation and Refraction (H49-H52) Astigmatism (astig. As, Ast) Esotropia Exotropia Hypermetropia/hyperopia Myopia (MY) Presbyopia Strabismus Word Parts eso- = inward trop/o = turning -ia = condition exo- = outward hyper- = excessive metr/o = measure -opia = vision condition my/o = to shut presby- = old age Astigmatism is a malcurvature of the cornea leading to blurred vision. If untreated, it may lead to asthenopia (literally weak vision) Esotropia is a turning inward of one or both eyes. Exotropia is an outward turning of one or both eyes. Hypermetropia (also termed hyperopia) is farsightedness. It is a refractive error that does not allow the eye to focus on nearby objects. Myopia is nearsightedness. It is a refractive error that does not allow the eye to focus on distant objects. Presbyopia is a progressive loss of elasticity of the lens (usually accompanies aging) that results in hyperopia. Strabismus is a general term for a lack of coordination between the eyes. It is sometimes called a squint. Mastering Healthcare Terminology/Chapter 14

Visual Disturbances and Blindness (H53-H54) Achromatopsia
Amblyopia ex anopsia Diplopia Hemianopsia Nyctalopia Photophobia Scotoma Word Parts a- = no, not, without chromat/o = color -opsia = vision condition ambly/o = dull, dim -opia = vision condition ex- = without an- = no, not, without dipl/o = double hemi- = half nyctal/o = night blindness phot/o = light -phobia = condition of fear, sensitivity scot/o = darkness -oma = mass, tumor Achromatopsia is an impairment of color vision. Types of color blindness include protanopia, deuteranopia, and tritanopia that are due to defective L, M, and S cones. Amblyopia ex anopsia is dull or dim vision due to disuse. Commonly called a lazy eye. Diplopia is double vision. Note that emmetropia is normal vision. Hemianopsia is loss of half of the visual field. May be the result of a cerebrovascular accident (stroke). Nyctalopia is an inability to see well in dim light. It may be due to a vitamin deficiency (A) or retinitis pigmentosa or choroidoretinitis. Photophobia is extreme sensitivity to light. A scotoma is a blindspot—an area of decreased vision in the visual field. Mastering Healthcare Terminology/Chapter 14

Other Disorders of Eye and Adnexa (H55-H57) Anisocoria Miosis
Mydriasis Nystagmus Word Parts an- = no, not, without is/o= equal cor/o = pupil mi/o = to close, constrict mydr/o = dilation -iasis = state Anisocoria is a condition of unequally sized pupils, sometimes due to pressure on the optic nerve as a result of trauma or lesion. Miosis is an excessive and/or prolonged constriction of the pupil. Mydriasis is an excessive and/or prolonged dilation of the pupil. Nystagmus is an involuntary, back and forth eye movement due to a disorder of the labyrinth of the ear and/or parts of the nervous system associated with rhythmic eye movements. Anisocoria Mastering Healthcare Terminology/Chapter 14

Be Careful! Do not confuse: esotropia, exotropia, entropion, ectropion
Nyctalopia means night blindness, not night vision See how similar the first four are? Students will need to develop a means to separate them from each other. The two letters (al) in nyctalopia refer to a blindness, not a vision, as -opia by itself would. Mastering Healthcare Terminology/Chapter 14

Benign and Malignant Neoplasms Choroidal hemangioma
Intraocular melanoma Retinoblastoma Word Parts choroid/o = choroid hemangi/o = blood vessel -oma = tumor, mass intra- = within ocul/o = eye melan/o = dark, black retin/o = retina blast/o = embryonic, immature A choroidal hemangioma is a benign tumor of the blood vessel layer under the retina (the choroid layer). It may cause visual loss or retinal detachment. An intraocular melanoma is a malignant tumor of the choroid, ciliary body, or iris that usually occurs in individuals in their 50s or 60s. A retinoblastoma is an inherited malignant condition that is present at birth. It arises from embryonic retinal cells. Retinoblastoma Mastering Healthcare Terminology/Chapter 14

Review Question What is the term for loss of half of one’s visual field? A. nyctalopia B. scotoma C. achromatopsia D. hemianopsia D. hemianopsia Mastering Healthcare Terminology/Chapter 14

Diagnostic Procedures Amsler grid Diopters Fluorescein staining
Gonioscopy Ophthalmoscopy Amsler grid showing visual changes caused by fluid leakage under the retina From Seidel: Mosby’s guide to physical examination, ed 6, Mosby Word Parts goni/o = angle -scopy = viewing ophthalm/o = eye An Amsler grid is used to assess central vision and to assist in the diagnosis of age-related macular degeneration. Diopters are levels of measurement that quantify the refraction errors, including the amount of nearsightedness (negative numbers), farsightedness (positive numbers), and astigmatism. Fluorescein angiography (angi/o = vessel + -graphy = process of recording) is a procedure to confirm suspected retinal disease by injection of a fluorescein dye into the eye and use of a camera to record the vessels of the retina. Fluorescein staining is the use of a dye dropped into the eyes that allows differential staining of abnormalities of the cornea. Gonioscopy (goni/o = angle + -scopy = process of viewing) is a visualization of the angle of the anterior chamber of the eye; it is used to diagnose glaucoma and to inspect ocular movement. Ophthalmic sonography (son/o = sound + -graphy = process of recording) is the use of high-frequency sound waves to image the interior of the eye when opacities prevent other imaging techniques. It may be used for diagnosing retinal detachments, inflammatory conditions, vascular malformations, and suspicious masses. Ophthalmoscopy (ophthalm/o = eye + -scopy = process of viewing) is any visual examination of the interior of the eye with an ophthalmoscope (-scope = instrument to view). Mastering Healthcare Terminology/Chapter 14

Diagnostic Procedures
Schirmer tear test Slit lamp examination Tonometry Visual acuity (VA) assessment Snellen chart Snellen chart A Schirmer tear test is done to determine the amount of tear production; it is useful in diagnosing dry eye (xerophthalmia). A slit lamp examination is part of a routine eye examination; it is used to examine the various layers of the eye. Medications may be used to dilate the pupils (mydriatics), numb the eye (anesthetics), or dye the eye (fluorescein staining). Tonometry (ton/o = tone, tension + -metry = process of measurement) is a measurement of intraocular pressure (IOP) used in the diagnosis of glaucoma. In Goldmann applanation tonometry, the eye is numbed and measurements are taken directly on the eye. In air-puff tonometry, a puff of air is blown onto the cornea. Visual acuity (VA) assessment is a test of the clearness or sharpness of vision; it is also called the Snellen test. Normal vision is described as being 20/20. The top figure is the number of feet the examinee is standing from the Snellen chart; the bottom figure is the number of feet a normal person would be from the chart and still be able to read the smallest letters. Thus, if the result is 20/40, the highest line that the individual can read is what a person with normal vision can read at 40 feet. Mastering Healthcare Terminology/Chapter 14

Terms Related to Diagnostic Procedures
Visual field (VF) test A visual field (VF) test is done to determine the area of physical space visible to an individual. A normal visual field is 65 degrees upward, 75 degrees downward, 60 degrees inward, and 90 degrees outward. How could this be used to diagnose hemianopsia? (loss of half the visual field) Assessment of visual fields From Black and Hawks: Medical-surgical nursing, ed 8, Saunders Mastering Healthcare Terminology/Chapter 14

Review Question Which diagnostic procedure is used to visualize the angle of the anterior chamber of the eye? A. ophthalmoscopy B. gonioscopy C. ophthalmic sonography D. tonometry gonioscopy Goni/o = angle Mastering Healthcare Terminology/Chapter 14

Procedures Blepharorrhaphy Canthorrhaphy Conjunctivoplasty
Cyclodiathermy Word Parts blephar/o = eyelid -plasty = surgically forming canth/o = corner (of eye) -rrhaphy = suturing conjunctiv/o = conjunctiva cycl/o = ciliary body dia- = through therm/o = temperature, heat -y = process of Blepharorrhaphy (blephar/o = eyelid + -rrhaphy = suturing) is a surgical repair of the eyelids. It may be done to correct blepharoptosis or blepharochalasis. Canthorrhaphy is a suturing of the upper and lower eyelids to prevent them from opening. A conjunctivoplasty is the forming of a new or restored conjunctiva that may require the use of a grafting procedure from the tissue of the cheek or other eye. Cyclodiathermy is the use of heat to destroy part of the ciliary body for the treatment of glaucoma. Destroying the ciliary body reduces the amount of aqueous humor, which then reduces intraocular pressure. If light is used, it is termed cyclophotocoagulation. Blepharoplasty Mastering Healthcare Terminology/Chapter 14

Procedures Enucleation of eyeball Evisceration of eyeball
Enucleation of the eye is the removal of the entire eyeball. Evisceration of the eye is the removal of the contents of the eyeball, leaving the outer coat (the sclera) intact. Enucleation of eyeball From Swartz: Textbook of physical diagnosis, history and examination, ed 5, Saunders Mastering Healthcare Terminology/Chapter 14

Refractive, Scleral, and Corneal Procedures Radial keratotomy
Keratectomy Keratoplasty Laser-assisted in situ keratomileusis (LASIK) Word Parts kerat/o = cornea -tomy = cutting -ectomy = cutting out -plasty = surgically forming -milieusis = Greek word for carving A radial keratotomy is a cutting of the cornea in a spokelike fashion in order to flatten it and correct myopia. A keratectomy is the cutting out of part or all of the cornea to remove a lesion. A keratoplasty forms a new or restored cornea. It is a transplantation of corneal tissue from a donor or the patient’s own (autograft) cornea. It may be either a full- or a partial-thickness graft. LASIK. Laser-assisted in situ keratomileusis (LASIK) is a flap procedure in which an excimer laser is used to remove material under the corneal flap. It corrects astigmatism, myopia, and hyperopia. LASIK Mastering Healthcare Terminology/Chapter 14

Phacoemulsification with/without intraocular lens (IOL)
Lens Procedures Phacoemulsification with/without intraocular lens (IOL) Word Parts phac/o = lens ex- = out tract/o = pull intra- = within extra- = outside ocul/o = eye Cataract extraction (ex- = out + tract/o = pull + -ion = process of) is the removal of the lens to treat cataracts. It may be intracapsular (ICCE), in which the entire lens and capsule are removed, or extracapsular (ECCE), in which the lens capsule is left in place. Intraocular (intra- = within + ocul/o = eye + -ar = pertaining to) lenses are artificial lenses implanted behind the iris and in front of the natural abnormal lens to treat nearsightedness and farsightedness. These are also called implantable contact lenses. Phacoemulsification (phac/o = lens) and aspiration of a cataract is a vision corrective procedure accomplished through the destruction and removal of the contents of the capsule by breaking it into small pieces and removing the pieces by suction (aspiration). Cataract extraction Mastering Healthcare Terminology/Chapter 14

Iris Interventions Iridectomy Iridoplasty Word Parts irid/o = iris
-ectomy = cutting out -plasty = surgically forming An iridectomy is a cutting out of all or part of the iris. The reason for the procedure is to allow the aqueous humor to flow out of the anterior chamber. It is used to treat closed-angle glaucoma. An iridoplasty is the surgical forming of a new or restored iris with laser treatment that allows the drainage of aqueous humor through an enlarged opening. It is also used to treat closed- angle glaucoma. Mastering Healthcare Terminology/Chapter 14

Retina Interventions Vitrectomy Word Parts Scleral buckling
vitre/o = vitreous humor, glasssy -ectomy = cutting out scler/o = sclera, hard A vitrectomy is a removal of part or all of the vitreous humor. Scleral buckling is a reattachment of the retina with a cryoprobe (cry/o = extreme cold) and the use of a silicone sponge to push the sclera in toward the retinal scar; it includes the removal of fluid from the subretinal space. Scleral buckling Mastering Healthcare Terminology/Chapter 14

Pharmacology Antibiotics Antiglaucoma drugs Antihistamines
Cycloplegics Lubricants Miotics Mydriatics Ophthalmics Topical anesthetics Antibiotics: medications used to treat bacterial infections. Antiglaucoma drugs: decrease the intraocular pressure by decreasing the amount of fluid in the eye or increasing the drainage. Antihistamines: drugs used to treat allergic conditions such as itchy or watery eyes. Cycloplegics: induce paralysis of the ciliary body to allow examination of the eye. Lubricants: keep the eyes moist, mimicking natural tears. Miotics: cause the pupils to constrict; often used to treat glaucoma. Mydriatics: cause the pupils to dilate; used in diagnostic and refractive examination of the eye. Ophthalmics: drugs applied directly to the eye. These may be in the form of solutions or ointments. Topical anesthetics: temporarily anesthetize the eye for the purpose of examination. Mastering Healthcare Terminology/Chapter 14

Review Question Which of the following is a procedure to repair the pupil? A. scleral buckling B. goniotomy C. keratectomy D. coreoplasty D. coreoplasty Mastering Healthcare Terminology/Chapter 14

Recognizing Suffixes for PCS
-ectomy excision, resection -plasty reposition, repair, replacement, supplement -rrhaphy repair -tomy drainage, repair Mastering Healthcare Terminology/Chapter 14

Sort these terms into their correct categories
1. diopters 2. keratitis 3. canthus 4. scleral buckling 5. xerophthalmia Categories __ A+P __ Pathology __ Procedures A+P – canthus Pathology – xerophthalmia, keratitis Procedures – diopters, scleral buckling

Chapter Thirteen Eye and Adnexa

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Chapter Thirteen Eye and Adnexa

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